Refining ARVC Risk Stratification: Does Left Ventricular Late Gadolinium Enhancement Add Incremental Value to Clinical Risk Calculators?

Introduction: The Evolving Landscape of ARVC Risk Assessment

Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) remains one of the most challenging conditions for clinical electrophysiologists and cardiologists. Characterized by the progressive replacement of myocardium with fibro-fatty tissue, ARVC is a leading cause of sudden cardiac death (SCD) in young adults and athletes. Historically, risk stratification has relied on the 2010 Task Force Criteria (TFC), which focused heavily on right ventricular (RV) morphology and electrical instability. However, the development of the ARVC risk calculator—a validated tool that estimates the risk of incident sustained ventricular arrhythmia (VA)—represented a significant leap forward in personalized medicine.

Despite the success of the ARVC risk calculator, a persistent question in the field has been the role of left ventricular (LV) involvement. As our understanding of ARVC has shifted from a purely right-sided disease to a potentially biventricular or even left-dominant condition, clinicians have increasingly looked toward Cardiac Magnetic Resonance (CMR) imaging, specifically Late Gadolinium Enhancement (LGE), to identify high-risk phenotypes. The study by De Marco et al., published in Circulation: Arrhythmia and Electrophysiology, seeks to answer whether the presence of LV LGE provides a necessary refinement to the existing risk models.